Matt Taibbi says that Rahm Emanuel’s health care debacle could be to the Obama administration what the Iraq war was to George Bush.

He’s right.

Matt says that progressives in the House might not vote for a bill that does not have a public option. If that’s true, it’s because of external pressure, not internal resolve. They were dragged kicking and screaming to that position. They knew — as we did — in late June that co-ops were going to be fobbed off as a "public plan." They did not want to publicly commit to draw a line in the sand.

June 15: Max Baucus announces his "co-op" plan, which was quite obviously developed to substitute for the public plan. Jerrold Nadler rightly calls it a "fake public plan."

June 23: We announce our whip count effort to get members of Congress to pledge to vote against any health care bill without a strong public plan. "The American public is on our side, and they need to know that Kent Conrad’s co-op plan is just kabuki."

June 24: Leaders of the Quad Caucus come together to say that they represent 117 members of the House who will vote against any health care bill that does not have a robust public option. But when readers call the offices of individual members, nobody will confirm this. We’re told by Hill staffers that they believe naming no names makes this stronger, and they’re angry at us for calling attention to the weakness of their strategy to hide under the umbrella of the caucus.

July 1: Donna Edwards, someone that the online community raised hundreds of thousands of dollars for in her two runs for the House, who campaigned on health care reform, won’t return my emails or calls for 10 days, so I write about it.

July 9: Lynn Woolsey says she’s got 60 votes who will vote against any bill that doesn’t have a public option. I wrote that "if Lynn Woolsey’s got 60 votes, I’ve got leprechauns in my laundry room." Having been through the supplemental battle and knowing the value of having those commitments be public, I said if she had them, she should name them.

July 9: When progressive members of congress simply will not answer our questions or those of their constituents about what they’ll do if there’s no public plan in the final bill, we hire Mike Stark to go up on Capitol Hill and confront them with a simple question: will you or won’t you commit to voting against a bill that does not have a strong public option?

July 15: The Progressive Caucus "leaks" a list with the names of 50 members who will not vote for a plan that "does not meet the Progressive Caucus criteria," incluging a strong public plan.

July 30: 53 (later 57) progressive members of the House sign a letter saying that they will vote against a bill that gives in to the demands of Mike Ross and the Blue Dogs on the Energy & Commerce committee, who insist that a public plan not be tied to Medicare reimbursement rates.

August 1: Mazie Hirono speaks the truth: "Ultimately, Hirono said she was a progressive who firmly believes in the public option, but that she was also someone who counted votes and that the White House would be pressuring them to make a deal."

August 3:Progressives, led by Jan Schakowsky, cave to the Blue Dogs, who get what they want on Energy & Commerce. In exchange, progressives get a symbolic vote on single payer that will not pass. Pelosi laughs at the idea that in the end, they would vote against any health care bill and keep it from passing.

August 14: At Netroots Nation, Donna Edwards asks me if we’ll do a campaign to thank the 57 progressives who signed the letter saying they would vote down any bill that didn’t have a public option tied to Medicare. I said they gave that up three days later. She assured me that it would be in the final House bill.

August 17: The 57 members of Congress add 3 more to their number, and they sign a letter saying that they won’t vote for any bill THROUGH CONFERENCE that doesn’t have a strong public option.

August 20: The Hill reports that there are those among the 60 signatories who would accept co-ops as a public plan, and others who don’t think the commitment holds through conference. Among those who signed the letter and now won’t say what they would do in conference: Donna Edwards.

Let me ask you a question. Do you think that the people who gave money to these members of Congress for making a promise to hold the line on the public option THROUGH CONFERENCE are going to flush this one down the memory hole? That people in strong progressive districts are going to forget this commitment, and they’ll just stand by while they swap out co-ops for a true public plan?

I don’t think so.

If this pressure was exerted from within the progressive caucus, it would be one thing. But it wasn’t. This was created externally, by a true grassroots movement, without the support of MoveOn, HCAN, the unions, the think tanks, or any of the other normal well-funded progressive validators living in the veal pen, who have been AWOL through the whole thing. Rahm told them to sit on the sidelines, and they have.

But instead of repeating the mistakes of the Republicans, who allowed their representatives to line up behind George Bush and walk their party over the cliff, grass roots progressives are the ones who are taking control of the health care debate. They have rejected the discredited progressive leadership of the veal pen, and they are telling their progressive members of Congress that they will not accept a health care bill with a co-op "bait and switch."

178 Responses
to “If Progressive Members of the House Think We’ll Accept Co-Ops As Public Plan, Think Again”

Matt Taibbi will be joining us at FDL for live chat on his latest article about the health care fight (coming in Friday’s issue of Rolling Stone), Tuesday, 8/25, at Noon EDT. I believe Jane will be hosting the discussion.

Any progressive who votes against the Public Option and FOR some watered down bullcrap, should be considered a sell out. We dont have to have a bill this year, we can wait. Let these bought and paid for Senators to be further exposed for the millions they got in campaign contributions to keep single payer and now the Public Option off the table. What is off the table is these co-ops, just another give away to corporate america. Colorada, Florida, North Carolina and Texas all started co-ops in 94 and 95, they went belly up in 2000! Why are any of the blue dogs pushing these idiotic plans, adding more confusion to already over heated debate.

Rahm Emmanuel is the sellout and its time Obama take that cat to the woodshed. He made the deal with Big Pharma to keep our drug costs as expensive as they are. Obama is listening to the WRONG people inside his cabinent. He needs to immediately MAN UP and deliver on the public option. He must keep his word to progressives. In my State progressives are furious with Obama and the democrats they wholeheartedly supported. If he doesnt support us, the democrats will lose the next election and we will never get a change in health care.

We did not elect Obama to create a “one” party system! Thinking the repukes are going to do anything to help this cause, is absolutely naive. Hilary may have been right. Obama needs a back bone, and stand up to HIS own party. Get them on board, or we progressives will overturn them state by state and elect real and known citizens who are progressives.

What selise said. Is it too late to ask for expanded eligibility options for Medicare? For example, you are eligible to opt-in to Medicare if you aren’t already in a group plan? The phrase ‘public option’ is turning into dog meat.

Jane, at what point will you finally bite the bullet and say flat out that the problem right now is Obama and the White House — that its Obama and Rahm and Messina and the rest of that crew that has to be targeted?

Face it, Donna Edwards isn’t vacillating because of pressure from AHIP, or PhRMA, or a bunch of wingnuts screaming “death panels”. She’s going all squishly and spineless because of pressure from the White House.

Its well past time that you bit the bullet and started telling the truth, even if it means that you finally are forced to deal with the rage of the Oborg. Obama has betrayed his progressive supporters — period.

Stop blaming baucus, and conrad, and AHIP and PhRMA, and acknowledge that they are all working in concert with Obama and Rahm…. and that progressives have to stand up to the White House.

(Not to mention the fact that the media will eat up this approach — the media thrives on conflict, which is why the “death panel” crazies got all the attention while progressives were wringing their hands….)

it seems to me that people keep blaming Rahm for what is going on. Rahm may well be the architect of this strategy — but Obama is the guy who is building the house, and approved the plans.

we need to recognize that there is no sign of a power struggle in the White House, and no evidence that there is any “dissension” on health care. Everyone is working pretty much from the same page — the messaging may be confused at times, but that appears to merely be the result of people (e.g. Sibelius) getting ahead of the overall strategy….

Donna Edwards isn’t vacillating because of pressure from AHIP, or PhRMA, or a bunch of wingnuts screaming “death panels”. She’s going all squishly and spineless because of pressure from the White House.

i’m pretty stupid about these things, but i think the idea is to “encourage” donna edwards and the rest of the progressives to stand up to obama. because obama, the blue dogs, the conservadems, ahip and phrma could care less what any progressive outside of deecee thinks or does. but maybe, just maybe, donna edwards and other progressives in congress do care enough about their supporters to do the right thing if they have a little “encouragment.”

The forces arrayed against any public plan would have all the same objections to that. It’s not the terminology they care about, they will oppose any policy that poses a real threat to the profits of private insurance companies.

Jane just a quick question… Has the money donated already gone into the coffers of these progressives or is it being held until they follow through on their commitment with a vote? Seems to me a carrot works better if it doesn’t get eaten before the horse does what you need it to do.

Just to be clear, I have not yet chipped in, because the PC has failed us on too many occasions for me to trust them. Once they actually earn my trust through effective action (not some half-hearted kabuki followed with the usual, “oh well, we tried”), then I’ll chip in. A lot. Just to make a point.

I went to the Event Tracker to find out where my Senators and Congressman will be holding town hall meetings. Neither Kaufman, Carper or Castle are going to hold any. Why? These three blind mice are all republican and democrat in name only. Both Carper and Castle have received millions in campaign contributions. Both are fearful the public is going to expose them for their right wing neo con views. Castle looked like a dear caught in the headlights when the lunatic from Sussex County went nuts. So he is not holding any. Tom Carper the carpetbagger from WVA, held a one hour radio show yesterday….he was so misinformed, so uneducated on the topic he looked like a buffoon. This man is no democrat. He has been a staunch supporter of the big banksters, credit card companies, insurance companies a real corporate whore. I did get a call into him and asked him, “how can the citizens of Delaware expect YOU to be an honest broker on health care when you took millions from the insurance companies”. He actually denied it was millions???? Oh my bad…not millions Senator, only $1.8 million? These blue dogs should be sent packing. He was pushing the CO op plans. I asked him, “are you aware that 4 states already tried co-ops and all failed and went bankrupt in 2000″. He obviously had NO information and stated “I will vote for the bipartisan bill”….what bipartisan bill. This man is a sellout not only to corporte delaware, but the nation as a whole.

If we want progressive ideas in this country, elect progressives. I too am concerned the progressives will appear to support the public option, but they will cave to the blue dogs. Obama is making me ill with his bi partisan crap. Who the hell cares what the repukes want. they are the minority party with no power. If these dems cant deliver, we should just fold our tent and go home? Not so fast. I believe that many liberaterians would join the progresives and push for a public option. Am sorry, but it was RAHM who met with Big Pharma and sold us out. Obama is of course under the spell of that man, who should never have been made chief of staff. He is a back slapping thug who cant get the blue dogs on board, but is attacking the progressives who the majority of citizens support? Come on.

You are many things selise, but stupid isn’t one ; ) You are spot on. The only leverage we have is in the House (which doesn’t mean we can’t make life miserable for Senators while we are at it), but Obama not so much.

G’Morning, Selise. You’re not stupid, in any sense. And, to those who question how Jane is leading this whip count, Jane’s not stupid either. She seems to have established a huge base of like minded grass-root workers and has had a huge and affective affect on the whole campaign. One would think she knows best what works.

if medicare isn’t expanded by, say age group (kids 0-18, down to 55, or similar) then it looses its single payer features and will suffer from adverse selection, etc. it’s tricky. don’t want reform to eff up the parts of medicare that work.

if my explanation doesn’t make any sense, you might take a look at scarecrow’s diary and especially comment @11:

Donna Edwards is my Representative. If she backs off the commitment to support only a HCR bill with a robust public plan through conference, I will (1) demand back any monies given to her campaign*s*, (2) *not* provide any support financial or otherwise for 2010, (3) be very public about this stance.

I expect politicians to live up to their word. When they don’t, there should be–there must be consequences.

thanks phred and demi, but when it comes to this kind of thing, i really am kinda slow. demi, the day we’re not suppose to question is the day i go find another party. jane is very very smart and dedicated but we’re all human and it’s not fair to expect her (or anyone) to always get everything perfect the first go.

Both of my senators, Klobuchar and Franken, are making noises that they’ll go along with co-ops (or as it should be called, co-opts). I saw a couple days ago someone identified two or three states that have co-ops already in place and they’re miserable failures. It’d be handy to get links to some details on that so I can try and talk my senators down from being stupid. I’m convinced they’ve been filled with bunkum from the White House about co-ops being “just as good”.

So if anyone has links to where existing health care co-ops have failed to contain costs or provide coverage, I’d appreciate seeing them.

Obama and Rahm are, as Taibbi says, creating a Dem version of the war in Iraq. IMO Obama and Rahm are the main problem, the problem we are fighting against. Jane’s leverage aside, they are driving the debate.

i love how they’re mad that we’re holding their feet to the fire. what a bunch of pussies, and not the good kind either.

I’ll be calling mr. fattah and mr. brady and remind them that if they vote for a co-op instead of a real public option, that I will be forced to write a column about them. A column that reaches 100,000 readers, mostly progressive Democrats, in their stronghold of Philadelphia.

Coops are just sand in your eyes. Like Jane maintains, the original intent was universal healthcare and the public option was a compromise. Let’s not give that away.

PS Just wrote this to Senator Tester:

Senator Tester:

Before you were elected, I and several others saw in you an American who we could be proud of. We supported you with donations and publicity. We celebrated your victory.

Now we need you. Because healthcare for everyone is a priority the nation cannot afford to ignore. We have millions unemployed, millions uninsured, millions filing bankruptcy from health costs. Our spirit as a country is being sapped by this drain on our emotions.

It is not a question of money. One way or the other, that money gets to the table today, and I am sure it will get to the table tomorrow. Perhaps through catastrophic insurance from the government and participatory deductible dollars from the people: those details will get ironed out by people smarter than I.

It is a question of who we are as a country. This great nation deserves to carry the health of its citizens as proudly as our soldiers carry our flag. If not now, when? If not us, who?

we need to recognize that there is no sign of a power struggle in the White House, and no evidence that there is any “dissension” on health care.

Where is Peter Orszag on this? Has he slipped off the radar. He understands (and I thought Obama did, too) that nothing short of a public option is going to reduce the horrendous cost of American health care. The economy cannot support the present system. If they go with co-ops, it is going to be Afghanistan (present disaster) all over again. I have to believe that the economists in the administration are appalled by the co-op solution.

Right. Anyone can question anything they want. At anytime. But, the whole concept of hitting one rep at a time, whether it was Jane and Howie during the election campaign (more and better…), or this HC campaign, it seems to me to be affective strategy.

I’d suggest that progressives have enormous leverage — all they need to do is start saying stuff like “If Obama can’t be trusted on health care, what can he be trusted on?” out loud and in public and you’ll see the media come running to cover that story.

The ultimate question is whether “progressives” are to be an autonomous group, or whether they are to be treated as an easily ignored segment of the Democratic Party. As long as we pull our punches about Obama, we’re just a bunch of Democrats whose complaints can be safely ignored…

Obama has decided that being the “historic” frontman for the the Insurance Companies, Big PhRMA and other special interests is far more fun and less work than being a real leader.

My only “hope” now is that he gets the living hell primaried out of him, so we get the “change” we deserve. We did not work, contribute and vote for this sell-out to mythical bi-partisanship. We did all that for a leader not afraid to use the “bully pulpit” with his cogent, soaring oratorical skills and demonstrated leadership having run an “underdog” campaign. Not a guy who caves in to the likes of Chuck Grassley and Max “Contributions” Baucus.

Taibbi is an astute observer of the modern cesspool that is politics, and I find he’s not often wrong about much. I think his analogy is spot-on here, and where the Iraq War has turned into Mess O’Potamia, Health Care has turned into Lie-a-palooza, with a healthy dose of cowardice from Obama thrown in.

Maybe Health Care starts with a Spine Transplant beginning with Obama and working it’s way through the allegedly Democratic caucus.

They have rejected the discredited progressive leadership of the veal pen, and they are telling their progressive members of Congress that they will not accept a health care bill with a co-op “bait and switch.”

!!!

fierce, concise writing.

you’ve nailed the jello to the wall, now keep the cameras on it and watch for the slippage . . .

OT, but Move-On sure has moved on from opposing the occupations in Iraq & Afghanistan, as well.

Good question about Orzag. It looks like he’s being muzzled here, because he has (as you note) pretty much disappeared from the discussion. (Indeed, I don’t recall Orzag being around when the PhRMA sellout was being discussed either.)

Please let President Obama know that without a public option, mandates are off the table. This would be suicide for Democrats since it would be wildly unpopular, especially with the youth vote that is so far mostly Democratic.

A mandate without a public option would constitute an increased rent for the insurance industry, allowing health insurers to extract a regressive hidden tax from millions more people. Beyond being wildly unpopular — if you think the debate is raucous now, just wait — it will also tank the US economy by extracting more profits for the insurance industry without increasing productivity and therefore real wealth.

Economically and politically it is a bust. Congress must tell the president, “No deal.”

Hey, they’re segregating the protest crowds at today’s town hall in (is it?) Florida.
Next, they’ll be telling them, You, with the semi-automatics go stand over there. Regular shotguns, to the right. People with knives and clubs stand in the back.

This is why I’m giving money to Howard Dean and DFA. There is no wobble in their position. My Congressman, Bob Brady, should be a vocal supporter of a strong public option. But so far, no peep from Bob. Given that he’s in leadership, that’s bothersome. I have called and written so far.

I wasn’t able to make NN09-so I sent roughly what I was going to spend on my hotel to help keep the Whip Count Project going. Yesterday, I was trying to figure out where I could squeeze out some money to send to the supporting fund-now I find that firm Congressional support for robust public option? Maybe NSM.

Glad I waited. I’ll send any additional money I can scrape up to Jane and Co instead. At least then I know it will go to getting results rather than kabuki.

In response to your question earlier this morning, which I just saw, Amy’s hosting the 1st WMNF Peace Awards being held at a big restaurant at the Tampa Bay Performing Arts Center. She’s also nominated for the award. I can’t afford the $75 ticket right now. *g* Kismet says hello.

its probably even worse than that. i suscribe tot the “cynical” beleif that this is just exactly where he (obama) wanted to come out on this..that the “PO” was NEVER anything he expected to push for. He used the PO to move the “center” of negotiations to the right, becuase…well because why??? thats where im at. i cant support obama. I’ll NEVER moive any further right. but i will not support Obama for president, or for anything else again. He is a manipulativr guy. he can CLAIM he never ran to the left, but that is a lie. he actively sought the support Of DFA, Howard dean and the democratic left by portraying himself as a liberal. So he’s willing to lie and backstab. so what separates him from any of the republicans we’ve excoritaed for the last 9 years?

Unfortunately, this is not enough, in my opinion. It is not enough to threaten an incumbent with withdrawl of your individual contribution.

Depending on how this all pans out, the “left of the left” may want to consider what an effective “or else” would be, when dealing with elected officials. I have long felt that the left will be essentially ignored until officials learn to respect the left. Politically, respect is often based in fear. Elected officials do not respect the left because they do not have to fear any political consequences in ignoring, or crossing us. This is simply objectively and inherently true, imo.

The ultimate question is whether “progressives” are to be an autonomous group, or whether they are to be treated as an easily ignored segment of the Democratic Party. As long as we pull our punches about Obama, we’re just a bunch of Democrats whose complaints can be safely ignored…

thats the spirit!

media will badly distort any schisms, so the point isn’t really to get media attn, though . . .

actually, “Jello Jay” Rockefeller is the chair of the health subcommittee in Finance, not Kerry. But Rockefeller is an outspoken advocate for the “public option” — and the fact that he is not even part of the “gang of six” despite being from a relatively conservative state (West Virginia) suggests volumes about how long the betrayal of the pre-compromised “public option” patsies was in the cards.
_
I mean, I can see not using “liberal” Kerry in negotiations with the GOP — but shutting out Jello Jay!?! That is really significant.

George Lakoff–finally–has a new post on Huff Po about the direction needed for how we are talking about health care:

Some ideas
This is–

The American Plan. Health care is a patriotic issue. It is what your countrymen are engaged in because Americans care about each other… Progressives should be stressing the patriotic nature of having our nation guaranteeing care for our people.

A Health Care Emergency. Americans are suffering and dying because of the failure of insurance company health care. 50 million have no insurance at all, and millions of those who do are denied necessary care or lose their insurance. We can’t wait any longer. It’s an emergency. We have to act now to end the suffering and death.

Doctor-Patient care. This is what the public plan is really about. Call it that. You have said it, buried in PolicySpeak. Use the slogan. Repeat it. Have every spokesperson repeat it.

Coverage is not care. You think you’re insured. You very well may not be, because insurance companies make money by denying you care.

Deny you care… Use the words. That’s what all the paperwork and administrative costs of insurance companies are about – denying you care if they can.

Insurance company profit-based plans. The bottom line is the bottom line for insurance companies. Say it.

Doctors care; insurance companies don’t. A public plan aims to put care back into the hands of doctors.

Insurance company bureaucrats. Obama mentions them, but there is no consistent uproar about them. The term needs to come into common parlance.

Insurance companies ration care.

Insurance companies are inefficient and wasteful. A large chunk of your health care dollar is not going for health care when you buy from insurance companies.

Insurance companies govern your lives. They have more power over you than even governments have. They make life and death decisions. And they are accountable only to profit, not to citizens.

The health care failure is an insurance company failure. Why keep a failing system? Augment it. Give an alternative.

prepare to give time and money. the DFA organization (have you ever checked it out?) is preparing to run primary candiadtes against some of the key offenders. of course its not entirely certain who the “key” offenders are yet.

I forced Brutus out from under the couch last evening. He’s now in the computer room where I spend a lot of time. Had to make some location changes in feeding the canned food tigers and that has upset everybody. One in the bedroom cuz her food has meds in it, 2 in the bathroom cuz they’re isolated the least amount of time and 1 in the computer room. The dry food tigers are upset cuz they can’t get into the other rooms so we’re not gonna eat, so there, too. Worse than kids.

Heat index here is about 100-110. They sleep all day, tear the place up at night. Reminds me of Charlie and roads. We fix the roads during the day, Charlie blows ‘em up at night. *g*

media will badly distort any schisms, so the point isn’t really to get media attn, though . . .

I agree about the media distortion, but without media attention, its like the tree that falls in the forest when there is no one to hear the crash it makes… the religious right holds so much sway over the GOP because they are willing to criticize the GOP (and its leaders) when they don’t live up to their demands.

If, as Frank Zappa noted, politicians constitute the entertainment wing of the military-industrial complex, it is not inconceivable that the healthcare charade’s main function is to take the focus off bloated Pentagon and defense contractor budgets. After all, Obama has been about as chatty on the topic of Pentagon spending as Dick Cheney. When Congress and the White House go on record that the country’s inability to adopt a system of healthcare similar to other advanced nations is not precluded by the fact we account for 54% of the planet’s military spending, I will gladly accept any corn-dog justification of the current system’s drawbacks.

Obama is a third way (now new Democrat) Democrat in the style of Bill Clinton. Obama’s admiration for Clinton is demonstrated by the appointments of many Clinton retreads. I shall not forget that Obama said that Joe Lieberman was his mentor in the Senate.

All the corporation-favoring, anti-labor, anti-citizen shit Clinton did (eg: NAFTA, welfare reform, DOMA and DADT) are a greatest-hits package for Obama.

The only reason the Democratic Party exists is to keep the majority of Americans who believe in progressive change from having any effect. Electing more Democrats will make them even more effective at this. If we created a Progressive Party and it was totally futile, it would still be an improvement.

Notice how the antiwar movement vanished the moment we elected Democrats to stop the war, and now there are more troops in Iraq/Afghanistan than there were then, and even more on the way?

Prohibition on negotiatin with drug companies for better deals? Forcing people to buy health insurance from private insurers, and spending tax dollars to subsidize their profits and executive salaries? Wall Street bailout? Cramdown? Free rein for credit card companies? FISA? Torture? State secrets? Illegal wiretapping? Signing statements? DOMA/DA-DT? Ending Bush tax cuts? Drug war? Guns in the streets and national parks and at political rallies? What an awesome new administration we’ve elected.

Just to be clear, I know Kerry is not the chair of the health care subcommittee. However, he is one of my Senators and I generally find that I get a better response (and sometimes even a returned call) as a constituent. I would suggest everyone take a peek at the membership of that subcommittee. If one of your critters is on the list, give them a call and put them on the spot. Lets shame these people into doing their jobs.

I just called Donna Edwards’s office; said that I’d contributed (from Mass.) to her campaign; that I was disgusted with her inconsistency and vacillation on medical care for all Americans; and that she’d better vote THROUGH CONFERENCE against anything failing to provide medical care for all Americans, or she wouldn’t get another cent out of me.

I’ve given to Accountability Now since it’s inception. I’m not sure what the status is on that, at present. But primary challenges and/or negative ads in home districts are the kinds of things that seem more likely to be effective, imo.

That said, leadership on this is needed. I don’t have the time or the expertise needed, so I look to Jane, Glen Greenwald and a few others to point the way, when the time comes.

The WH is fairly behind the curve in all of this because they, and I probably mean Rahm, persist in strategies that don’t work before changing gears. The current plan is to sell co-ops as the public plan to get the Blue Dogs and Senate onboard and then to peal off progressives as needed to ensure passage in the House. And to threaten them with taking the blame if whatever healthcare bill that does come up fails. As this article from the WaPo on Dean which is far more laudatory of him than I would be states:

“What Howard is doing is principled but destructive,” said a Democratic strategist and former Dean adviser who spoke on the condition of anonymity because of the sensitivity of the intraparty debate. “If health-care reform goes down because of the public option, it’s going to be the liberals that bring it down, the Democrats doing it to themselves.”

If co-ops as public plan should fail nonetheless, Obama and Rahm have a fallback position. That is to present a completely gutted public plan, one that won’t start up until 2013, that won’t be competitive with public plans, that will be strangled financially, that will be divorced from and more expensive than Medicare, that will be available to almost no one, and that will cover almost nothing.

This is why it is important to make sure that progressives in the House commit to not just voting for any public plan, but a strong or robust one,adequately funded and available to all within one year at rates and with services comparable to Medicare and able to bargain with Medicare for better better rates and services from healthcare providers.

Now if progressives hold the line on this, it could sink the current bill. That is why we need a fallback position as well and that should be along the lines of what letgetitdone and scarecrow have suggested in other posts. Minimally, we should support reform of the insurance companies’ worst practices, like rescission, prior conditions, high rates for the personally insured, etc. To make it more interesting I would also like to see premium caps of inflation rate plus 1% increase per year. The howlig and mewling would worth it for that alone.

I’m fully in agreement. But in our strategy we do have to target, persuade those who we can impact. We also have to follow through to show there is a consequence for those who turn their backs to us and take us for granted.

For one I am tired of having my voice ignored. Some Rahm’s belittling of me has given me the fire I need to see this through.

“Remember, though: Don’t look backward! We traded away getting to the bottom of the torture/wiretapping/no-bid, non-contract assassination outsourcing, so as not to “suck up all the political oxygen” for universal health care the public option regional co-ops.” by David Waldman.

With political will, the Weiner Amendment need not be symbolic. And it cuts one huge Gordian knot. And if Democrats have the guts to move it through rapidly into law, Obama will sign it, and once people start getting the benefits of it, the controversy goes away. Are these politicians so lacking in a sense of self-survival to understand this?

When you try to co-opt the industry you are trying to regulate, it becomes a question at some point of who exactly is co-opting whom?

*Sigh* just *Sigh*

So, the Congressional Progressive Caucus has flim-flammed their reliable ATMs for campaign funds once again.

If this pressure was exerted from within the progressive caucus, it would be one thing. But it wasn’t. This was created externally, by a true grassroots movement…

Yes, and that means DC and its usual assumptions and ‘transactional’ approach to politics aren’t working, so they’re befuddled.hahahahahahah!!!

Does anyone think that intensity of feeling is just going to go away?

Not a chance. The frustation’s going to build as people feel that we’ve bailed out AIG, Citigroup, BofA, and the very people who created mounds of debt while charging us outrageous interest are now getting screwed by the same brainless political trolls who handed our collective asses to AIG.

That people will simply accept Obama’s “goody bag” of health care toenail clippings which delivers nothing but a political victory for him, and give up on their dreams of delivery from the current health care system? Taibbi’s right — this will be to Obama what the Iraq War was to Bush.

Taibbi’s seeing inside the political wormhole on health care.

If Rahm Emmanuel can’t figure out that what the healthCo’s really want is to end up with Obama in a health care version of the Codpiece Outfit on an aircraft carrier beneath a HealthCo written version of “Mission Accomplished: We Can Cover Who We Damn Well Please At Whatever We Damn Well Want To Charge and The Rest of You Are Toast, HaHaHa“, then he’s not as smart as he’s reputed to be.

Dang it. They are prepared now. I got a lot of stammering and confused silence. Usually I get irritated on the phone with these people, but when I called the other day I felt only bemused pity. Still, I’ll keep harrassing them. It will still be fun : )

I went to the Donna Edwards Town Hall week before last.
She seemed pretty forceful about a public option (albeit couched “in some form”).
When I spoke with her personally afterwards, I mentioned my brother’s experience with the VA.
The DC VA hospital/clinics are part of the Georgetown University resident rotation, hence, the attendings are professors with residents. It has been extremely good from our perspective.

Donna thought this was a great model and thanked me for giving her the details.

There has been little discussion here on allowing the insurance industry the rollback of the 25% the patient pays for care to 35%, as currenly being discussed in the Senate Finance Committee.

Is this the insurance industry’s plan to cut the expense increase the profits of health care? To force the policy holder to shoulder 35% of the costs of care, up from 25%, and impose a mandate on the uninsured?

That’s just brilliant! Malignant, but brilliant. Some health Insurance Reform. I wonder how to get this message to the teabaggers? We do have a common cause.

My inner cynic has been reborn. My idealism of the 70’s disentegrated working the polls & watching my town locals accept the shot of booze & a $5 bill before going into the voting booth.

My local town is now the online progressive community, and I’ve been there every step of the way getting Dems elected to Congress & the White House. Yet, in the past few months that idealism has hit a brick wall of cynicism again as I watch the people we’ve elected not even put up a PR fight, let alone stand for anything they are not willing to negotiate away.

yes the problem that really the only power we have to retaliate would be primaries (negative ads are useless without a primary) and that cant be until we know who were throwing parties for. it can be everyone.

Why would I “target” people who are impervious to our pressure? It’s the mistake that liberal activists have been making for decades, it’s why they’re getting their asses kicked

.

you really think that Obama is impervious to our pressure? That the media would not report on a major rebellion by the progressive grassroots (indeed, that it would exagerate the impact of even a minor rebellion by the grassroots?).

Its nice that you’ve raised $170K… but that’s peanuts when compared to what PhRMA, AHIP, AHA and the rest of the parasites are willing to spend — and you and everyone else knows it. The media covers your “peanuts” because it involves conflict — and the media feeds on conflict.

The difference between us and the wingnuts is that we’re not crazy. We can point to how Obama has lied to us about his commitment to a public option, how he’s making backroom deals with drug companies, and how Obama is now signalling a willingness to force Americans to buy insurance from companies that have been forced to pay hundreds of millions of dollars in fines for underhanded insurance practices — and who are literally committing murder by spreadsheet.

It is the compromise. That’s why the progressives and their organizations need to tank the PO now and go back to Medicare for All as the position we are supporting and insisting on. Any compromise isn’t relevant until we’re in a situation where no bill at all can be passed because everyone is deadlocked. At that point compromises can be made in the context of the legislative process with progressives in Congress understanding that even a Jacob Hacker-type PO is an inadequate solution that is barely acceptable to the progressive movement. This will require upping the ante for progressives in Congress. They need to take HR 676 seriously and pledge to vote no on anything else. Hold the line until the Administration faces defeat. At that point it will deal and so will the Blue Dogs. Remember, they are not in the safe districts.

If all else fails and a comprehensive Medicare for All or Hacker-type PO bill cannot be passed then a back-up strategy can still work. That strategy is outlined here, and amplified here.

Jane is the only person who has called out Rahm on national television for his role in this disaster; I don’t know how you can say she hasn’t helped raise awareness that it is Rahm and the White House who are orchestrating this.

It’s not a co-op, it’s a funded program. But the problem really isn’t in what something’s called, the problem is the Democrats will not accept anything that limits the profits of the insurance companies, hospital corporations or drug manufacturers.

ads usually as part of primaries, I agree, but not necessarily only as part of primaries. One might envision scenarios where ads, robocalls, etc. could be run just about any time, depending on the context of the issue and the nature of the district.

Jane: Please address this! Breitbart.tv has a video up. PROGRESSIVES OUTING OBAMA ON HIS DRUG DEAL! A secret deal, not to touch the high cost of drugs in this country! We cannot buy our drugs in volume or outside the country to lower the price of drugs! WE HAVE BEEN CHENEYED! PLEASE PROGRESSIVES ADDRESS THIS ISSUE. THIS IS ANOTHER SELL OUT TO BIG PHARMA…HOW CAN OBAMA CLAIM HE IS BEING HONEST WITH US.

Just now! Jan Ting a REPUBLICAN candidate for Congress, and a Professor just stated that “he is heavily supporting single payer health care”. Yes, THERE ARE SOME SANE REPUBLICANS OUT THERE. I personally couldnt believe this man would go against his party on this issue. But he has! He and his students studied every country and their systems and they came to the conclusion the only SOLUTION IS SINGLE PAYER…..IT AINT OVER FOLKS.

My recommendation is that we use every possible opportunity to remind our legislators and the media that ANY healthcare reform plan MUST address each of three separate but interrelated problems: universal quality coverage, affordability to consumers, and system-wide cost-growth containment. The third goal is largely getting lost in the public debate about this issue, and yet it’s the fulcrum on which this whole healthcare reform effort balances.

It may be theoretically possible (but incredibly unlikely) that co-ops can solve the first two issues (depending on how much taxpayer funds we’re prepared to throw at ‘em and how strong the employer and individual mandates are), but there’s absolutely no way that one can tackle the third problem (exploding costs to the economy) with an insurance-company-sponsored boondoggle to avoid real competition from an efficient public plan (which is what the co-ops are really all about).

Unless the conservaDems can explain to us how co-ops will achieve the third objective when they’re working with the insurers to specifically design the co-ops to fail to do so, the co-op concept is dead in the water, as it should be. So far I’ve heard only deafening silence from co-op advocates regarding cost containment and competition. It is apparent that, by design, they will fail to reign in the insurers. With co-ops, the insurers will be able to rip off not only consumers and employers, as they are now doing, but also acquire a new mark to scam – the Federal government. The concept of (decentralized) co-ops are about massive subsidy without accountability or additional negotiating power for the public, and as such they must be assumed to be a fail.

that’s actually my point. But it wasn’t the “whipping” of House Dems by the FDL crew that got the media attention, it was the outcry created when Sibelius said that the public option was not necessary to reform.

Jane thinks we can’t influence Obama. I think we can — by changing the parameters of the public debate. And the most effective way to influence that debate is to raise serious questions about Obama’s honesty, integrity, and character. Obama knows he can’t afford for the phrase “Obama can’t be trusted” to become a central part of the media lexicon this early in his admininstration — and by making it clear that progressives will harp on Obama’s lack of integrity every chance they get if he doesn’t make sure that a strong public option is the MINIMUM acceptable health care reform from congress.

how about those who come with only torches and pitchforks? Do BC/BS and United HealthCare employees get their own area too? Do they have to show company IDs and their emailed protest orders from senior management?

Teddy — Rahm isn’t the problem. Obama is the problem. Obama doesn’t care if Rahm gets criticized — but if Jane goes on Olbermann and points to Obama as the guy who is making the sweetheart deals with PhRMA and trying to force americans to buy insurance from for profit parasites, instead of fulfilling his promises to provide a strong public option that saves money by cutting costs on drugs, Obama WILL care.

Jane,
Just wanted to say thank you and all for your commitment. I have mitigated my cynicism enough to man the phone every morning calling and even being polite when I want to yell at the stupidity.
Props to ya
Burnie

thank you for making that point succinctly. Rahm is a foil for the president. His job is to take the heat, float the trial balloons, and cut the deals. Any Chief of Staff who leads with his own agenda is very quickly an ex-Chief of Staff. If he speaks, it’s because his boss wants him to.

The only way we influence the president (not Rahm, who simply does not matter) is to tell him clearly and effectively what we really want. Not to complain about his factotum or dance around our real agenda. I’m reasonably optimistic that if we’re vocal, articulate and smart about it, the president will listen. That message to the president has to be, must-have public option, must-have strong employer and consumer mandates, must be universal and affordable, must be prepared to abandon this bi-partisan non-sense when its so very clear that its leading nowhere.

No, it’s not too late to demand effective health care reform. We need to shout “Medicare for All”, following the model of the outraged Iranians. And, like them, we need to take to the streets to insure that the Obama administration respects the needs of those who worked so hard to get them elected.

Medicare is a very popular program. Even some of the hecklers paid to oppose the public option say they want their Medicare. Let’s demand that our Democratic House, Senate and White House give us “Medicare for All” and end the nonesense about insurance exchanges, cooperatives and more give aways to corrupt private insurers.

I’m such a beaten down bleeding heart, having worked in health care. I think if I were in the progressive caucus, I might vote for any crumbs Pharma and Insurance will allow us to have. I’d tell them, okay, let us insure a few more desperate people and take your billions or trillions in profits. Good thing I don’t have a vote.

Which is why Jane’s focus on the Congress members is exactly right, and why I tell folks ready to throw in the towel because “Obama’s thrown us under the bus” is that we do not have an imperial Presidency only because we do not let the executive govern by fiat and backroom deal.

Jane, isn’t it time we changed our cry from “support the public option” to “Medicare for All”. We accepted the public option as a compromise from single-payer. The Republicans and Blue Cross Dems are refusing to compromise. Let’s go back to single payer with the slogan of “Medicare for All”. This existing program known and liked by millions of Americans. If they don’t have it themselves, their mother, father or grandmother does.

The so-called “public option” is diffuse and undefined. People don’t understand what the proposed plan would do for their individual situation. They understand what Medicare care would do.

We need to demand “Medicare for All” and all of America, excepting a few of the crazies, will support it.

you really think that Obama is impervious to our pressure? That the media would not report on a major rebellion by the progressive grassroots (indeed, that it would exagerate the impact of even a minor rebellion by the grassroots?).

ummm.. yeah. More likely, the next 47 million (who are presently insured) well find themselves presumptively forced into the co-ops, and the current 47 million uninsured remain uninsured. Premiums and deductibles double.

It is disconcerting and exasperating to see such idiots comment on the TV news, in this case the idiot being Dick Gregory. Obama today on the radio show of Mike Stepanish? made it clear that he wants the PO as one of the choices available within Health Care reform. Immediately afterward when asked to comment, this moron Gregory says that Obama’s problem is that he is not clear on what he wants his health care plan to include.

This man is an idiot and will not be deterred by something which he has just heard in maintaining the opposite. Whatever his motivations, if any, I think it is best to infer that the man is a fool and needs to be taken as such.

Obama by his deeds has shown himself to be unreliable and perfectly willing to sacrifice the public’s interest in favor of the private financial and giant corporate interests. So I have nothing but disdain for the man. But to have commentators of such ridiculous stupidity grace our networks is deflating. Thank god there is this great alternative via the net.

All the more reason to act directly through our representatives and impose on them our wishes for meaningful reform of the health care system. I am a physician and can see clearly the need for reform and that only through requiring our elected officials to publicly commit their support for legislation that contains the PO will we attain the change that is needed.

no. absolutely unacceptable. The premiums reflect between 35-50% outright waste by most studies, and they’ve been far outstripping inflation to date. System costs need to come down immediately by, say, half of that 35-50% and any future increases (which is what the public plan will force the privates to do, if this is all properly structured), and the public plan should set the standard for future price increases. And I will make a strong case that should be the rate of real wage growth for Americans in the second and third quartile of US wage-earners, which has stagnated at near zero-growth for the last 30 years.

remember, they charge that 25-30% (which Baucus wants to increase to 35%) AFTER they and others outright waste 35-50% of total system costs. Baselining this thing internal to the current pricing mechanism is going to be next-to-impossible.

Which is exactly why the government must, through competition, provide price leadership for the private market, and the way to do so is through a strong public plan. Healthcare has an extremely low elasticity of demand (people will pay almost any price – beg, borrow and steal to get the care they need). And the insurers have, to date, exploited this low elasticity with complete irresponsibility, failing to achieve a disciplined and balanced approach to competitively pricing their own services or, for that matter, controlling the proliferation of waste and dead-loss. A new competitive agent – the public plan – has to be introduced to get this back under control, reimposing a real economic rationale for healthcare services pricing and moving the operation of the industry back toward its efficient frontier (by reducing the waste and increasing productivity). If the other side has another way to do this, I’m all ears, but so far, they have nothing.

Just as Obama and Rahm are trying to sell co-ops as the public option, Dean tries to sell the public option as single payer. It isn’t. Insofar as Dean is for a public option that looks a lot like Medicare I would agree with him. Insofar as he doesn’t, I would not. Dean also seems to buy into the notion of multiple payers and competition. Real competition has been fairly thoroughly debunked. People really can’t shop their health. Most wouldn’t even know how to if they could. So price needs to be controlled externally. The market won’t work. Also because only a few insurers dominate most markets the likelihood of competition is small. Dean thinks that conservatives are running scared on healthcare. I think they are laughing all the way to the bank.

I’m going to commit heresy to say that I’m actually not sold on single-payer (although I like it a lot better than the co-ops). I prefer government price-leadership through a strong public plan. Of all solutions, that approach will create, I believe, the least bureaucracy and be the most political palatable. I also believe that, done correctly, it’s also the best way to increase productivity, achieve cost-growth containment, and reduce waste in the industry.

I was trying to introduce an element of flexibility. Insurers and providers might say that no supplemental would freeze out new techniques and innovations. 1% would give them as much or more money than what the NIH gets for its research so I was being generous.

Again by the nature of the fact that your health is not like a car where you can shop around for the best price and possibly even live with your choice even if it wasn’t a particularly good one, competition doesn’t work in this market, the market can not efficiently set prices or determine services. Many markets have only a few near monopoly players in them. Price restraint has to be done by external control such as you see with Medicare currently where it is allowed to do so and more completely and efficiently by sigle payer if it were instituted.

Jane, I get pretty cynical sometimes about what we can accomplish, but then I remind myself that I’m a guy who saw freedom riders heading for the South in 1960 and thought they were so naive to think they could change anything that way (I got with it later). If supporting and/or embarrassing our progressive reps is the only leverage we have, then we use it, and your TV appearances are magnificent. I know it isn’t 1960, but there’s a lot I don’t know too about what is possible. So I support your effort, despite my whimpering at 130. My rep is in the progressive caucus and on our committed list. At first I thought, geez it seemed too easy to get that from him, since we couldn’t get him to vote against war funding despite raising hell. It was too easy. We have to keep on them to not back out now.

actually, you just repeated exactly what I just said. Which is why the public option as a price-setter will work extremely well here, obviating the need for outright socialization… precisely because the mechanism you and I outlined in our posts above work so well. Take a look at the Singaporean or some of the better European systems, for example. Essentially, the public option will control waste and contain prices (both for the government and for consumers and businesses). The private insurers become price-takers to that public option, with the further incentive to provide better service for cost (unlikely) and, more importantly, preventing margin compression by forcing efficiencies on healthcare providers and pharmacos, probably better than the government can, since their incentive (to stay alive from their disadvantaged position as price takers) will be stronger than of the government’s to do so themselves. Minimal standards of care will be assured, since the government public option will set the competitive standard.

Well if it is the public option that becomes the price setter, the private system becomes redundant and only has a niche as it does in European countries where for extra you can get in to a doctor a little faster or have access to slightly better specialists.

no, because of the system-wide cost-and-efficiency crisis. The amount of waste in this system and the exploding costs, simultaneous with the amount of waste (17% of GDP already!) implicate that the entire system is operating well below the productivity efficient frontier. To become competitive with the European and Asian systems cited, which provide as good or better care for a fraction of our cost, this system must first move to that efficient frontier or at least a lot closer to it. Government, acting alone, has historically not been the best way to get this to happen.

I’m saying the public plan will inevitably take away the absurdly generous carrot that the privates have today (and which will continue in the case of single-payer, since everything the government-only system will be base-lined on the awful levels of performance we have today) and will just hit the private sector repeatedly with big sticks – sticks that’ll goad them in putting pressure on pharma and providers and on themselves, to move us toward the frontier much more quickly than government can (remember, Medicare costs are running away too). Government as price-setter, privates as price-takers forced to save themselves from competitive margin compression under the government price umbrella by passing on the pressure they will be put under to the providers and pharmco’s, forcing reform of the care system itself. Public plan price-setting could continuously raise the performance bar by dropping the price bar, every time the government sees excess margin expansion at the privates, therefore repeatedly increasing efficiency in the system toward pareto-optimum. Once we get the entire price-service mechanism to levels comparable with the best world systems, then we can talk about switching to single-payer if we still want to (but we won’t have to do that). It’ll work.

I saw all those progblogs urging suckers to send money to the 60 “heroes”, and was amazed at how often the netroots is not only willing to kick Lucy’s football, but will actually seek her out unprompted and offer to do it.

After being burned and betrayed so many times by the sellout CPC, you’d think that progressives would have learned by now not to trust their empty promises. But they donated close to $200k, and now – imagine my surprise – CPC members are trying to weasle out of their position. When I saw the donation drive, I simply laughed – I won’t give a penny to a CPC rep until either Obama signs a bill with a viable public option, or that rep votes against a bad healthcare bill all the way to the bitter end.

Dear Netroots: if you want the CPC to stop getting rolled by Rahm, then stop letting the CPC roll you!

Reading your exchange with interest, and thought I’d throw in an unsolicited comment or two (that perhaps you already assume):

First, none (or very little )of the price-setting will occur unless consumers are free to move on and off the public plan at will, without causal events.

Second, and perhaps more important, private insurance companies would have to be held to the same set of regulations (no recsission, no denial for pre-existing conditions, etc.) that this hypothetical public plan would meet, otherwise you run into the same problem as Medicare faces now in terms of risk groups.

I’m thinking the second point is the huge stumbling block since the willpower to enforce regulations is, umm, lacking at times.

At Netroots Nation, Donna Edwards asks me if we’ll do a campaign to thank the 57 progressives who signed the letter saying they would vote down any bill that didn’t have a public option tied to Medicare

This woman’s gall is staggering. I trust we won’t be seeing any more solicitations for campaign donations for her on FDL.

Thanks for that. Those are both great points. Yes, I had assumed your first point, and my understanding is that the currently proposed system would allow such free movement to occur.. well, for at least the vast majority of people who have the option of a private plan.

I’m going to have to think about second one more. You’re right, but I’m wondering how “tight” those restrictions would have to be and still work to overcome moral hazard and the risk groups issue.. at first blush the restrictions on privates may not need to be total, especially if most consumers can freely move between the two plans. Somehow we have to prevent the private system from chasing those employer-funded customers they don’t want into the public system (to your point). Whole life-cycle-based HMO regulation would be one means to do so, but as you point out some direct restrictions on fair access will have to there as well. Regulation of the employer-paid policies will be key.

How do they address this issue (in patient movement between the various plan options) in MA and VA?

not sure what you mean by individual mandate. I use that term to refer to a requirement that ALL citizens MUST be covered by either the public option or a private-employer or other plan. If this system is to work, there can be absolutely no opt-outs – as this will mean inefficient and costly emergency-room care will still need to be provided to those who opt-out altogether. Everybody must be insured by somebody.. otherwise the whole economic logic for cost-containment and productivity-improvements (what will make this whole program workable and affordable) starts to fall apart.

We have to disagree. I don’t see the PO having the market power and effect you ascribe to it even under the best conditions. It’s sort of an “if but then” for me. If we could enact such a robust PO and it were so effective why would we need other insurers and if the PO could create such price economies on the system how is it that if it went to single payer it suddenly would lose this ability?

If one of your critters is on the list, give them a call and put them on the spot. Lets shame these people into doing their jobs

I approve of your thought/suggestion, but one of my Critters is Inouye, who knows absolutely no shame.

The local papers just had glowing articles and columns about how “necessary” it was for him to hold a fund-raiser last weekend that pulled in over a million dollars. The dude is 86 years old, there’s never any competition, and he BRAGS about his prowess with earmarks.

If Hawaii weren’t such a shithole, maybe there would be someone to run against him — from either party.

Jane thinks we can’t influence Obama. I think we can — by changing the parameters of the public debate. And the most effective way to influence that debate is to raise serious questions about Obama’s honesty, integrity, and character

Oh yeah, no chance there’d be any “collateral damage” with that strategy.

I disagree. This could be Obama’s Katrina. If there is no real reform which makes sure that everyone can get care, we will start to count the dead. The people who die every day until universal coverage is achieved.

If those who pledged, end up accepting a co-op package instead or anything less than the Public Option, there WILL be a grass roots progressives 3rd party which will take every vote they can from any Democratic “traitor” candidate next season.

Are you hearing the “conspiracy theories” out there picking off some progressives. Alex Jones is putting out information that the “swine flu” thing is another attempt to kill people. He claims that the vacines are not safe, have squalene in it causing cancer. Some of these so called progressives are making the jump that the untested swine flu vaccine and Obamas health care are one and the same.

There is a huge difference between Howard Dean and James Dean his brother. Howard as Governor never delivered a single payer health care system even though progressives were pushing him to do so. Its James (I think that is his first name) who is a strong advocate for single payer.

Medicare, Medicaid, and the VA are all single payer systems. We have them already. What the repukes are pushing today is for states to allow insurance companies across state borders to be able to go anywhere they want and that alone will bring down costs. Its a lie. Its nothing but a continuation of the for profit system, AND our Doctors hate it. Doctors at PNHP.org, claim they spend 40% of their time doing paperwork, hiring people who do nothing but paperwork. How would that plan help us, it wouldnt. Just more confusion added to the rest of the confusion.

jane, i came back hoping to find out what i did that pissed you off in this thread. i linked to democracy now!, scarecrow and you — i’m pretty sure that’s it. on the off chance you see this and are willing to explain, i’ll check back at some point.